Globe and Mail News

Eating Table

September 2009

One thing is clear: Most of us are eating too much salt. And that includes our kids. Nearly all toddlers and children in Canada consume about double the recommended amout of sodium every day, writes Carly Weeks in Monday’s Globe and Mail.

“One of the fundamental problems, according to a leading childhood obesity expert, is that the food industry has ‘programmed’ parents and children to accept that high-sodium items such as hot dogs and pizza are ‘kid-friendly,’ without considering the health consequences,” said Peter Nieman, a pediatrician at the Pediatric Weight Clinic in Calgary.

He is now online to take your questions on how to reduce sodium in the whole family’s diet, as well as more general questions on childhood nutrition and obesity.

Dr. Peter Nieman has been practicing as a pediatrician in Alberta since 1987. Dr. Nieman is currently on active staff at the Alberta Children’s Hospital and the Rockyview General Hospital and also works in a community-based consultant pediatric clinic. He is a faculty member at the University of Calgary as a clinical assistant professor in the Department of Pediatrics.

He is the co-founder of the Pediatric Weight Clinic, one of the first weight management clinics for children in Western Canada. He is a member of the Obesity Society, and serves on the Canadian Pediatric Society’s Healthy Active Living Committee.

With a keen interest in patient and media education, he is the host of his web site www.healthykids.ca, an educational site for parents and families.

12:03

Dr Peter Nieman: There are a number of experts who think salt may indeed be addictive. A most recent example is Dr Kessler—a former FDA commissioner— who wrote in his book that studies show salt may be addictive. It may impact neurotransmitters and lead to cravings. In my experience I think there is a fine line between addictions and craving….I prefer to use the term craving. I also think it’s possible to change with enough awareness and willpower!

12:05

[Comment From Laura ]

I try to limit items such as pizza or hot dogs to once a week and am fairly vigilant on not too many packaged items. I do however make lunches with ham or turkey from the deli. Do these items have too much salt in them for my kids?

12:06

Dr Peter Nieman: One more idea….by reducing the amount of salt day by day as opposed to using a “cold turkey approach” one can actually establish healthier habits. The longest journey here does start with the first step! And do yourself a favor a few weeks later by using the vast amount of salt you used before—you will not be able to stand the bad taste…

12:10

Dr Peter Nieman: Yes the items you mentioned (food from a deli) have too much salt. The issue really comes down to knowing how much salt there may be in advance. That way you can plan better. Salt is placed there to preserve the meats, but it may well be possible in future to lower the level. I am also encouraged by your plan to limit exposure to pizza and hot dogs to once a week. It is the cummulatative effect that ads up over time. Carly Weeks has done us all a great favor by bringing attention to this topic—we can now eat more mindfully and still enjoy it

12:10

[Comment From Peter Donato ]

is there a big difference between Sea Salt and table salt, and should we limit this too?

12:13

Dr Peter Nieman: That is a great question Peter….. My understanding is that salt is salt and that Sea Salt may often be marketed as better. I am not aware of recent per-reviewed data published in journals on this topic, but I shall look into that and write something on my own website later. The bottom line is this: we can easily reduce our salt intake, regardless of the source, by eating out less, planning in advance and comparing food labels. Dr Katz, from Yale, has a great website on reading labels with younger kids(www.nutritiondetectives.com)

12:13

[Comment From Len ]

Dr Nieman, should those who put their salt shaker away be concerned about not getting enough Iodine ?

12:16

Dr Peter Nieman: The reason behind fortifying salt with iodine is to help the thyroid function on all 4 cylinders. Even if you were to reduce salt you will still get enough iodine. I am glad you asked this question because it reminds me that salt is indeed a requirement…our bodies need it to function perfectly. But we went too far as the great graphs in the Globe today shows. I for one will cut the graph out Xerox it and place it in an exam room –it will remind my patient to be aware!

12:17

[Comment From Kristen ]

Dr Nieman, we have preschoolers that cannot be involved in the buying decision so is there a website that we can go to that lists low sodium snacks that we can simply use as a grocery list?

Dr Peter Nieman: My apologies…the site I mentioned works well because it is user friendly, it’s from Yale (Dr Katz) and it is colorful…meaning a parent can engage a child easier. The Dietitians of Canada also have great resources. So does the Heart and Stroke Foundation. All of these bodies want to help the public. Lastly the salt meter mentioned in the Globe works well too

12:20

[Comment From kay ]

Can you comment on the use of salt substitutes like Mrs Dash that contain potassium salts?

12:23

Dr Peter Nieman: These alternatives are there so that we can avoid sodium (salt) I think that the flavor is still there with Mrs Dash. It may be a great alternative, but one has to be sure there are no renal issues given the potassium content. I would suggest you also get a baseline blood pressure before you take it over the long-term. Most of these products are allowed on the market only after they have been deemed safe, but as Ronal Reagan said “Trust, but verify”

12:24

[Comment From A reader ]

If I don’t use any processed foods at home, do I need to be worried about my kids (aged 4 and 6) eating out two or three times a month? These restaurant meals are likely high in sodium.

12:28

Dr Peter Nieman: No I would not be concerned if I were you—3 times a month will not harm them. That reminds me to say that this whole issue is not about MDs or government spoiling fun; it is not about big brother telling us how to live; it is about raising awareness so that we can make some changes which will prevent troubles later. One can never start too young. My advice is to go out and eat–enjoy the food and ambiance! But be wise and do some of the things Carly Weeks mentioned such as avoiding the known high sodium contents. Avoid too much Ketchup by putting some on the side and dipping into it as opposed to drowning food under a red layer of high sodium!

12:28

[Comment From Katie ]

If you buy a pizza crust and make your own pizza at home w fresh veggies and less cheese, do you have the same concerns regarding salt intake? Also, I noticed on some baby food toddler jars that the salt content is alarmingly high. What type of items would you suggest you can feed a toddler when you are at a restaurant?

12:33

Dr Peter Nieman: I agree that when you make your own food –especially with fresh veggies–you will for sure expose those youngsters to better nutrition. I am meting more and more moms in my clinic (and I have done this for 26 years thus far) who make their own foods. Another benefit of this is one can shape their taste buds that way by starting young. A toddler should have lots of fruits and vegetables and soup lower in sodium (hard in restaurants) Avoid things such as Fries, Hot Dogs and pizza if possible. Or if you are like me (the father of picky eaters and young determined toddlers) cut the portions down. Also use terms they may like such as “Lets have more grow foods” “Have more carrot stick or veggie trees” Have little sodas or dilute fruits juices with sparkling water (less sugars but still has the fizz the like at that age)

12:36

[Comment From Amanda ]

Hi Dr. Nieman. My six year old is on the chubby side. I prepare healthy meals at home that are not high in calories and I encourage activity .I don’t think my child eats more than an average child of his age. I think he’s just built this way. But I don’t want to set him up for future problems. What can I do now? How much of this is related to his genes versus his diet and activity level?

12:37

Dr Peter Nieman: We always run out of time when we do these media clips. So I also want to suggest another resource full of great ideas on how to feed toddlers. Its a book by Dr William Sears (see www.askdrsears.com) It is full of recipes and ideas that are creative and above all practical

12:39

Dr Peter Nieman: Genes do play a big role. My friend in Chicago, Dr Kirschenbaum,a psychologist at North Western wrote a fine book (Sierras Solution) and in it he mentions that genes are a big part. Experts tell us up to 50% may be gene related. Just they way we are wired. However although we may not control genes we can certainly do a few things such as

12:42

Dr Peter Nieman: Things such as getting a baseline BMI, see if the BMI climbs over time or if it just stays stable and high; get a baseline cholesterol and insulin, check the BP, limit screen time to 2 hrs max/24hrs, aim for 30-60 minutes of activity per day and reduce portions. On my own site (www.healthkids.ca) I have so much more detail but I hope the ideas I gave you will be a good start. Please make sure you encourage him—do not pick on him. Find out if he is an emotional eater too. Many of these kids have been teased sadly and then they eat for comfort

12:43

[Comment From Concerned ]

Hi Dr. Nieman. Could you suggest some healthy snacks for kids (other than fruit & veggies) that don’t contain a lot of salt?

12:50

Dr Peter Nieman: Sure….some low fats cheese also have lower sodium(great source for protein) Another source may be eggs (pieces of boiled eggs on a low salt cracker–good source of some minerals and protein and the cholesterol issue is not as big as we previously thought) I find most kids easily get too many carbs and fats. I like protein sources added to snacks filled with carbs. Kids may not like fish per se, but small pieces of salmon can be a great snack too. Try putting a small amount of peanut butter on a banana. If you aver tried fruits and vegetables and it fails consider a fruit and vegetable supplement such as either Juice Plus or Greens Plus. Re snacks and liquids try water–even sparkling water to take away possible boredom. But in all fairness all of the above take time and planning, so let’s be realistic and aim for the best, knowing we cannot always hit the bull’s eye. A book “How to get your kids to eat but not too much” (Ellyn Satter) will offer many more ideas re healthy low salt snacks

12:52

[Comment From Eating out ]

Hello. We try to keep meals at home but we do end up eating out once or twice a week with the kids, mostly because of hectic after school schedules. What can I do at restaurants to keep meals healthy? Thank you.

12:58

Dr Peter Nieman: Here are some ideas re the hectic part (I am in the same boat now with my kids) Try to have some foods and snacks pre made and leave it in a plastic container for eating on the road–on the way to sport events for example or music lessons after school. Also make a smoothie rich in antioxidants(berries) in low fat milk with flaxseed and a scoop of soy or whey protein powder. In restaurants order from the starter section which may still have high sodium but less than the kids menu often. The more you used the same restaurant the more you know what to expect–you may even use their website to scout out the best foods beforehand and once it’s done you are set up for future. Try to get to the restaurant not too hungry by having a healthy snack bar in your pocket to be eaten on the way between the school and the restaurant or after school activities. Avoid a drive in window if at all possible. It takes just a bit of advance planning but once you have a habit or routine its easily duplicate able, but remember to have fun as a family

12:59

Rasha Mourtada, G: That’s all the time we have for today. Thank you, Dr. Nieman, for taking the time to be here today. Any last thoughts?

1:02

Dr Peter Nieman: Yes indeed….I want to tell all the parents who participated that they are investors! Their great questions tell me they care for their kids and want them to grow up healthy. An investment indeed into the future. In this case salt can cause lots of issues(Carly mentioned many, including a set up for high BP later; one cannot feel high BP thus it is the silent killer) So in summary have fun but beware and plan ahead. It is easier than you may think, and the front part is the hardest…once you are aware you can become more consistent and do not feel too guilty if you eat out once in a blue moon